1/13. Stanford type A aortic dissection in a hypertensive patient with atherosclerosis of aorta and aortitis.dissection of aorta is a serious condition; the main factors are hypertension and diseases of the connective tissue or of collagen. aortitis syndrome in combination with hypertension and atherosclerosis in association with ascending aortic dissection is rarely seen. We present the case of a 53-year-old hypertensive patient whose ascending aortic dissection was associated with pericardial effusion without rupture of the aorta and with pleural effusion. Several unusual aspects of transesophageal echocardiography are described. The intraoperative biopsy revealed inflammatory aortitis with mural hematoma, without giant cells. The literature concerning aortic dissection and aortitis is reviewed.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/13. Giant negative T waves during interferon therapy in a patient with chronic hepatitis c.interferon-alpha (IFN-alpha) has been widely used for treatment of chronic hepatitis c in japan. In general, cardiovascular adverse reactions are rare in association with IFN-alpha therapy. Here, a 64-year-old man with chronic active hepatitis c complained of fatigue, palpitation and depression, and developed atrial fibrillation with prominent negative T waves during IFN-alpha therapy. Echocardiogram showed septal and apical hypertrophy. Three days after discontinuation of IFN-alpha, subjective symptoms and atrial fibrillation subsided. It is unclear whether or not IFN-alpha induced the giant negative T waves with apical hypertrophy. We might observe the developing course of hepatitis c virus (HCV)-related myocardial hypertrophy by chance. Cardiovascular toxicity should be carefully monitored during IFN-alpha therapy even in patients with minor cardiac disease, such as premature ventricular contracture (PVC) and mild hypertension.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/13. Giant adrenal pseudocyst presenting with gastric outlet obstruction and hypertension.Adrenal pseudocysts are rare lesions that are usually nonfunctioning and asymptomatic. We describe a patient who presented with nonspecific upper abdominal pain, vomiting, and hypertension. ultrasonography and computed tomography revealed a giant left adrenal cyst. Routine laboratory tests and endocrine function tests were all normal. The patient underwent surgery, and the cyst was completely removed. Histologic examination showed that the cystic wall consisted of fibrous tissue without an epithelial or endothelial lining, and a diagnosis of an adrenal pseudocyst was made. Symptoms of pyloric obstruction resolved after pseudocyst removal. His blood pressure normalized and he was normotensive and symptom free 6 years after surgery.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/13. Multifocal Pott's disease (tuberculous spondylitis) incidentally detected on Tc-99m MDP bone and Ga-67 citrate scintigraphy in a patient with diabetes.Pott's disease is an uncommon extrapulmonary form of tuberculosis. Delay in diagnosis and management may cause serious complications. The authors describe Pott's disease incidentally detected on Tc-99m MDP bone and Ga-67 imaging in a patient with diabetes. Tc-99m MDP bone scintigraphy showed intensely increased uptake in the lower cervical spine and lumbosacral regions. Ga-67 scintigraphy revealed intensely increased uptake corresponding to the areas noted on Tc-99m MDP bone scintigraphy. magnetic resonance imaging showed destructive lesions in the C5-C6 and L5-S1 intervertebral discs with destruction of adjacent end plates. biopsy of the lumbosacral area was guided by computed tomography, and histologic examination of the bone specimen showed caseation, giant cells, and acid-fast bacilli. Posterior decompression and posterolateral spinal fusion with bone grafts were performed. Antituberculous chemotherapy with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. The patient showed remarkable relief of symptoms during a period of 9 months of therapy. Both Tc-99m MDP bone and Ga-67 imaging can offer the convenience of screening the entire body to detect multiple sites of Pott's disease.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
5/13. Giant negative U waves in a patient with uncontrolled hypertension and severe hypokalemia.A 66-year-old woman with a long history of hypertension had an electrocardiogram with giant negative U waves in left precordial leads despite hypokalemia. This seems to be the first report of giant negative U waves induced by uncontrolled hypertension with hypokalemia. The occurrence of negative U waves in the presence of profound hypokalemia is an important observation because it masks the electrocardiographic manifestation of hypokalemia.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
6/13. Thrombosed giant intracavernous aneurysm with subsequent spontaneous ipsilateral carotid artery occlusion.We report a case of a 47-year-old man with a giant thrombosed aneurysm of the right cavernous internal carotid artery who initially presented with headache, double vision and trigeminal numbness. He experienced subsequent asymtomatic proximal occlusion of the parent vessel, revealed by follow-up angiography. This case illustrates the possibility that a giant thrombosed aneurysm may exert enough compression upon the parent vessel to induce flow stasis with resultant intraluminal thrombosis progressing to occlude the entire parent artery.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
7/13. A case of mistaken identity: giant cystic pheochromocytoma.A 39-year-old Marshall islands woman was referred for evaluation of an abdominal mass. Medical history was significant only for pulmonary tuberculosis and scrofula. The patient denied a personal or family history of pancreatic or endocrine disease. physical examination revealed normal vital signs and a 12-cm mildly tender left upper quadrant mass. A computed tomography scan revealed an 11-cm cystic mass contiguous with the distal pancreas and closely associated with the hilum of the spleen and the left kidney. Based on these findings and the patient's history, a cystic neoplasm of the pancreas was suspected, and she was subsequently taken to the operating room for exploration. Intraoperatively, the patient became markedly hypertensive with manipulation of the mass, requiring intravenous nitroprusside. Histopathological evaluation confirmed the diagnosis of cystic pheochromocytoma (PCC). The patient's postoperative course was uncomplicated. Cystic PCCs may not present with the classic prodromal symptoms associated with solid PCCs. This case represents the complex and unsuspected presentation of an extremely rare functional cystic neoplasm. A high index of suspicion for cystic PCC is necessary when confronted with cystic lesions in the vicinity of the adrenal glands. Failure to recognize cystic PCC before resection may lead to uncontrollable hypertension in the operating room, with potentially serious consequences.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
8/13. Ocular ichemia syndrome - a malignant course of giant cell arteritis.PURPOSE: To call attention to a malignant course of ocular ischemic syndrome in patients with giant cell arteritis (GCA). methods/PATIENT: A 84-year-old woman developed severe headache for about 3 (1/2) months prior to myocardial infarction and visual disturbances. RESULTS: An anterior ischemic optic neuropathy (AION) in the right eye with a distinct reduction in visual acuity was found. The retina revealed several cotton-wool spots in both eyes. Serologic examinations showed inflammatory signs. Despite treatment with prednisolone, eye pressure decreased to 2 mm Hg in the right eye and 4 mm Hg in the left eye in a few days. An ischemic iritis developed in the right eye. visual acuity worsened to detection of hand motions in the right eye and to 0.1 in the left eye. Approximately 8 (1/2) months after her initial headache, a biopsy was carried out. The patient was treated continuously with corticosteroids. histology of the superficial temporal artery indicated inflammatory cells in the vessel wall. - The patients daughter developed symptoms of GCA at the age of 54 years. CONCLUSION: An ocular ischemic syndrome points to a malignant course of the disease. A cardiac infarction can develop in GCA. A biopsy of the temporal artery can reveal inflammatory changes even after 8 (1/2) months.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
9/13. Bilateral giant intracavernous carotid aneurysms in a 16-year-old boy.A case of bilateral, non-mycotic, giant intracavernous carotid aneurysms occurring in a hypertensive 16-year-old boy is reported. The pathogenesis of such aneurysms is discussed.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
10/13. Beware beta-adrenergic blockers in patients with severe urticaria!The risks of beta-blockers in asthmatics are well known. However, there are increasing reports of severe, and often refractory, anaphylaxis in patients taking beta-blockers who experience other allergic phenomena. We describe the case of a 69-year-old lady with long-standing recurrent angio-oedema and giant urticaria who was placed on atenolol. Mechanisms whereby beta-blockers may precipitate or exacerbate anaphylaxis are outlined and the treatment of patients with anaphylaxis, taking beta-blockers, is discussed.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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